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New Moms May Want to Avoid These Nursing Habits to Save Newborns' First Week of Life

Timothy Boyer Ph.D.'s picture
Prone nursing may increase risk of SIDS

A new study shows that while encouraging the practice of "Back-to-Sleep" for all infants back in the '90s has decreased SIDS overall, it has not done so for newborns in their first week of life. Here are some surprising nursing habits new moms may want to avoid during a newborn's first week of life.


According to a news release from Massachusetts General Hospital, a disturbing trend has emerged after a new study found that not all infants benefitted equally from the "Back-to-Sleep" Campaign that was initiated in 1994 for the prevention of Sudden Infant Death Syndrome (SIDS).

The "Back-to-Sleep" Campaign was a collaboration between the National Institute of Child Health and Development, the American Academy of Pediatrics (AAP), the Maternal and Child Health Bureau of the Health Resources and Services Administration and SIDS groups back in 1994 that encouraged new mothers to put their babies to sleep on their backs rather than their tummies in order to reduce the risk of SIDS.

SIDS and Sleeping With Your Infant, Good Idea or Bad?

The collaboration was considered a success as research shows that between 1993 and 2010 the percent of infants placed to sleep on their backs increased from 17% to 73% resulting in a significant decrease in the number of infants dying from SIDS and SUIDS yearly. SUIDS is the sudden, unexpected death of an apparently healthy, full-term infant under 1 year of age, the cause of which is not immediately apparent. Presumed causes of unexplained deaths include accidental strangulation or suffocation caused by factors such as unsafe bedding, becoming trapped between a mattress and a wall, or sleeping with a parent or another adult who inadvertently blocks the infant's airway.

However, in spite of the program's success, a new study published recently in the Journal of Pediatrics finds that not all infants may have benefitted equally from the new infant sleep practice. As it turns out, the youngest infants--especially within the first week of life--show an increase in SIDS/SUIDS rates. The study's authors identified some potentially modifiable factors that may contribute to the persistent risk of sudden, unexplained death during the first days and weeks of life.

"The frequency of SUID in the first month of life is higher than generally recognized, at an average of 444 cases per year in the U.S., of which 66 per year occur on the first day and 130 occur in the first week of life," says lead author Joel Bass, MD, chair of the NWH Department of Pediatrics. "There actually has been a dramatic and unexpected increase in deaths attributed to suffocation and asphyxiation in both newborns and infants up to 1 year old, and these deaths are potentially preventable."

The Study's Findings

What the study found from analyzing neonatal (first 27 days of life) and postneonatal (28 days to 1 year) infant birth and death records from 1995 to 2014 was that:

1. Postneonatal SUID declined nearly 23 percent from 1995 to 2002, after which the rate remained stable.

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2. Neonatal SUID rates remained unchanged.

3. The percentage of SUID cases attributed to suffocation or strangulation increased in both age groups from around 2 percent to nearly 23 percent in the neonatal period, and from 3.4 percent to almost 25 percent in the postneonatal period.

4. Almost 30 percent of neonatal deaths occurred during the first 6 days of life. Many of which may be the result of sudden unexpected postnatal collapse (SUPC), a sudden collapse-sometimes with full respiratory and cardiac arrest-of an apparently healthy newborn born at more than 35 weeks' gestation.

5. Several recommended practices designed to promote breastfeeding, may inadvertently contribute to SUPC risks. For example, the practice of skin-to-skin care, in which an infant is placed in a prone position on the mother's chest has been noted in other reports to have a strong association with SUPC. If the mother is also exhausted or sedated, she may even fall asleep with the infant on her chest resulting in co-bedding, an established risk factor for SIDS. In addition, failure to introduce a pacifier in the neonatal period is another factor that could adversely affect postneonatal SUID rates. While nursing is strongly recommended and has been found to be associated with a reduced risk of SIDS, pacifiers may be helpful as well and merit reconsideration.

"Overall, we think it is possible that certain neonatal practices resulting in unsafe sleep circumstances both during and after the birth hospitalization, along with pacifier avoidance, may have inadvertently interfered with the implementation of safe-sleep messages and prevented a decrease in the death rate. Future research is needed to more fully explore the best messaging during the birth hospitalization that will enhance safe-sleep practices recommended by both the National Institutes of Health and the AAP and help to prevent SUID," stated Professor of Pediatrics and co-author Dr. Ronald Kleinman.

For more about newborn safety, here is an important article about recognizing risk factors that could prevent 95% of SIDS cases.


Massachusetts General Hospital news release (February 14, 2018) "Safe-sleep recommendations for infants have not reduced sudden deaths in newborns"

Journal of Pediatrics 2018 "Trends in the Incidence of Sudden Unexpected Infant Death in the Newborn: 1995-2014" Joel L. Bass et al.

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